Relationships, Resilience, and Relative Value Units: A Qualitative Study of the Promotion and Erosion of Humanistic...

Formal medical curricula increasingly emphasize humanism, yet humanistic practice (HP) is often described subjectively and little is known about how practicing clinicians experience and develop HP within contemporary healthcare environments.

To explore how practicing physicians conceptualize, develop, and experience HP, and to identify implications for undergraduate medical education.

Qualitative study using semi-structured focus groups.

Twenty-six physicians across multiple specialties and 15 U.S. states participated, recruited through professional listservs, investigator networks, and snowball sampling. Years in practice ranged from 0 to 53 (mean ~ 18).

Four 90-min virtual focus groups (six to seven participants each) were conducted in January-February 2023. Open-ended questions explored clinicians' understandings of HP and factors facilitating or impeding it. Transcripts were iteratively analyzed using thematic coding and reflexive discussion.

Five themes emerged. Clinicians described HP as relational and inseparable from competent care. HP was primarily cultivated through relationships with patients, mentors, and role models, and those humanistic relationships also supported clinician resilience. Participants noted ambiguities in defining HP and experienced substantial tensions between HP and healthcare system priorities focused on efficiency, standardization, and commercialization. The culture and pedagogies of medical training were also seen as undermining HP development, with clinicians describing their training as "damaging" to their native humanism.

Clinicians deeply value HP but face systemic and cultural forces that challenge its practice, making it essential to address both education and healthcare systems in sustaining humanistic care. Preparing future physicians to understand, resist, and creatively work within the constraints of an industrialized system is essential to ensuring that medicine remains a profoundly human endeavor.